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Is Femoral fracture fatal ?!

Traffic collisions in India are major source of deaths and injuries every year. The National Crime Records Bureau (NCRB) 2016 report states that road collisions accounted for 464,674 collisions, of which 148,707 deaths occurred as a result of collisions.

The Journal of Orthopaedic Trauma 2011 estimated the rate of femoral fractures to be 10% to 20% per 100,000 people annually. This rate is expected to be doubled by 2050.

FEMUR BONE: It is also called “Thighbone”.

The Femur bone is the longest and heaviest bone of our human body

ANATOMY OF BONE: It forms a Hip joint by fitting its head into the acetabulum of the hip bone. Within the capsule of the hip joint, the neck extends outwards and downwards from the head of the shaft. Posteriorly, the lower surface forms a popliteal surface. With the tibia and patella, the distal extremity has two articular condyles.

FUNCTIONS: It transmits the weight of the body through the bones below the knee to the foot.

PATHOLOGICAL EVENTS AFTER FRACTURE OF FEMORAL BONE:

The most important pathological events that accompany a fracture in bone are the formation of Emboli, trauma, deformity in the bone, inability to bear weight, an extension of fractures into other bones including tibia and distal femur.

A landmark legal case on the fracture of femur bone due to an accident and subsequent negligence in the degree of care during the treatment by the surgeon is as follows:

“Laxman Balakrishna Joshi vs. Trimbak Bapu Godbole and ANR”

Date of Judgment: 02/05/1968

Bench: Shelat,J.M ; Bhachawat, R.S ; Grover,A.N

Act: Tort — Negligence of Surgeon.

Facts of the case: On May 6, 1953, the son of the first respondent met with an accident at 5:30 pm, resulted in the fracture of the femur bone of the left leg, at a beach which is 14 miles away from the place their parents live. It took time to remove the patient to his house and by 8:30 pm, a local physician was called. The physician immobilized the leg immediately with a view to give rest to the patient and advised his parent's removal to Poona for treatment. On May 8, 1953, the local physician substituted the temporary wooden planks with Mae Intyres splints and placed the boy in a taxi in a reclined position. They started to Poona at about 1 am. After a journey of about 11 hours, the boy was admitted to Appellant’s hospital by 2:15 pm. The appellant after some preliminary examinations directed his assistant to give two injections of Morphia and 1/2000th grain of Hyoscine H.B at one-hour interval. The assistant gave only one dose and the patient was removed to X-ray room and subsequently into Operation theatre., where the injured leg was put into plaster splints, later the patient was shifted into the room assigned to him. Appellant — 1 gave assurance that the patient would be relieved from the effects of Morphia by 7 pm and hence Respondent — 1 left to Dhond and respondent — 2 remained with the patient. However, by 6:30 pm, the patient was having a cough, had difficulty in breathing, the temperature of the body went high, went into a coma, and was showing the signs of cerebral embolism. The assistant called the appellant and gave treatment in an emergency. Unfortunately, the patient died at 09:00 pm. The cause of death mentioned in the certificate was Cerebral Embolism.

ISSUES OF THE CASE: There were several issues raised upon the cause of death of the patient. There are: Did the Appellant perform all essential preliminary examinations for the boy before starting the treatment? Has enough care been taken when his leg was put into traction in the Operation theatre? Are the doses given by the assistant were in accordance with the directions given by the appellant? What was the content in the letter given by the appellant to the respondent after the death of the patient?

Court findings: On July 17, 1953, respondent -1 lodged a complaint on the appellant to the Bombay Medical Council and later appealed for High court.

The trial court and the High court findings are as follows: It was concluded that, notwithstanding the denial by the appellant, the appellant had performed the reduction of the fracture, in doing so, he applied excessive force with the help of other three attendants, and such reduction was done without giving any anesthesia. That resulted in Shock or cerebral embolism which was the proximate cause of the boy’s death.

The appellant said that all necessary examinations had been performed beforehand, but no records were maintained.

The assistant gave only one dose of Morphia, as the patient was showing more effects of the dose than anticipated.

The appellant issued a letter of apology in which he stated even he was not aware of the reason for the patient’s death.

The trial judge was of the view that this defense was an afterthought and was contrary to the evidence and circumstances of the evidence produced and hence he held the appellant guilty of negligence and wrongful acts, which resulted in the death of a patient and awarded general damages of sum Rs.3000/-.

JUDGMENT OF HIGH COURT:

After hearing the two parties, the high court concluded that death was due to shock resulting from the reduction of the fracture attempted by the appellant without taking the elementary caution giving anesthetic to the patient. The trial court and the high court were, therefore, right in holding that the appellant was guilty of negligence and wrongful acts towards the patient and was liable for the damages. The appeal was dismissed with the costs.

WHAT IS EMBOLISM?

Embolism is a Greek word meaning Interposition. Emboli are the particles that create a total or partial blockage of blood flow.

It forms as a result of Pathological events, accompanying any illness or injury.

Embolization is an intentional process of embolism used in several cases to kill the cancerous cells or to stop hemorrhage.

Depending on the kind of Emboli formed, there are different embolisms:

· If the emboli are blood clots that create a thrombus, it is called Thromboembolism.

· If the emboli are fat globules, it is called Fat Embolism.

· If the emboli are gas bubbles, it is called Gas Embolism.

· The emboli might sometimes be Cholesterol plaque crystals.

Based on the blood capillaries they enter, it is classified as :

· Arterial Embolism: Emboli that flow into arteries. The major cause is Infarction.

· Venous Embolism: Emboli that flows into the veins.

Deep vein thrombosis is caused by Pulmonary embolism.

· Paradoxical Embolism is a crossed embolism, where the emboli enter into the veins and then into arteries or vice — versa.

Fat embolism syndrome is commonly associated with trauma /bone fracture. It occurs rarely and resolves within days or weeks.

Symptoms include: appears within 24–72 hours after trauma.

· Shortness of breath

· Mental Confusion

· Increase in heart rate

· Decreased oxygen in the body

· Red spots on the skin

· Coma

· Fever

· Anemia

· Pinpoint rash (petechial rashes)

Cerebral embolism is a blood clot that originates somewhere else in the body, usually in the heart or in the neck blood vessels, that then travels to the brain. This creates a blockage of blood flow to blood flow and causes a stroke.

It usually lasts between 2 to 30 minutes.

Symptoms include:

· Sudden numbness

· Sudden confusion

· Sudden trouble in speech

· Sudden trouble in vision

· Sudden trouble to get up and walk

· Sudden dizziness

· Sudden loss of balance and coordination

· Sudden and severe headache

· Sudden shortness of breath

· Sudden increase in body temperature

CONSUMMATION:

All in all, Fracture in femur bone is found to be fatal if reasonable care and pre examinations are not conducted. As it is the longest bone and heaviest bone that bears the whole weight of your body, it requires more time to get healed.

The surgeon or medical officer attending such patients should not act negligent and should follow the guidelines as per Ethics and give the treatment with reasonable care according to the circumstances.

The medical practitioner has discretion in choosing the treatment which he proposes to give to the patient and such discretion should be wider in cases of emergency.

Thank you for reading my piece of article, and for any further questions or discussions, the comment box is open.

I’m a freelancing writer specialized in Pharmacy, medical and medico-legal topics. To reach me out, write to thepillandbar@gmail.com

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